Saturday, April 7, 2012

Health Care - Mandatory Insurance and Patriotism

Guess how many states have laws that REQUIRE citizens TO BUY insurance?  FIFTY.  That’s right, folks.  Every single one of them.   Red states as well as Blue states.  Require.  Citizens.  To Buy.  Insurance.  To be more specific, every single state requires citizens who drive motor vehicles to buy liability insurance to cover any damage they might inflict.

Now of course this law doesn’t apply to everyone.  There are two primary classes of people who do not have to buy automobile liability insurance.  Those who don’t drive.  And those can prove financial responsiblity to cover any damage they might cause up to a certain limit.

The rationale behind these laws REQUIRING citizens TO BUY liability insurance is simple.  There is a significant risk that anyone who drives a motor vehicle may, over the course of their lifetime, cause an accident which causes damage to the property or bodies of others.  There is a strong societal interest in making sure that those so injured can be compensated for their losses. You cannot buy insurance to cover an injury after you cause it. You have to have the insurance ahead of time.  The insurance covers the damages caused by negligent drivers.  Of course, this cost is paid for by all of the non-negligent drivers who pay their premiums every month without causing any damage.  Hence, the requirement that ALL drivers, negligent as well as careful, carry liability insurance.

Those of us who live on planet earth are also at significant risk of needing medical treatment at some point in our lives.  We may contract, carry or transmit a disease, be injured as the result of an accident, or develop some other illness or chronic condition – sometimes the result of our own choices, sometimes not.  There is a strong societal interest in making sure that those who need medical treatment can afford treatment for those illnesses.  There is also a strong societal interest in making sure that those who provide medical treatment are compensated for having done so.

Health insurance, like any other form of insurance, only works if there is a shared assumption of the risk.  Insurance companies rely on actuarial tables to assess the risk and base their rates accordingly (after factoring in a healthy profit of course).  Healthy people have to pay into the program so that sick people are covered.  Previously, insurance companies could refuse coverage or charge significantly higher rates for people with pre-existing medical conditions.  The current legislation seeks to prevent that by spreading the risk around to all citizens.

Now some may argue that health insurance is different than auto insurance because only people who drive motor vehicles have to purchase insurance.  Granted that is true, mandatory health insurance should only be required of citizens who might be expected to contract, carry, pass on, or suffer from a medical condition, or sustain an injury requiring medical treatment.  Of course, since all of us are mere mortals, this applies to everyone.  Only corpses are not at risk of needing health care.

Another option would be an opt-out provision, with the understanding that those who opt out are not entitled to receive any medical care treatment whatsoever that they cannot pay for prior to the administration of the treatment.  Kind of like buying broccoli at the grocery store – you can’t take it home and eat it until you’ve paid for it.  If you opt out and don’t have the money you’ll get no EMT care, no ambulance ride, no appendectomy, no CPR, no emergency room care, no cancer treatment, no life-saving procedures.  Nada.  Zip.  Nothing.  If you think this is a cruel approach to health care – leaving people to suffer or die who can’t afford treatment - I agree with you.  But what justification for entitlement to treatment can people give who, given the chance to share the risk with the rest of us, REFUSE to do so?

Mandatory health insurance, or in the alternative, national health care, is PATRIOTIC.  It exemplifies the highest ideals of the American public – a willingness to stand up with our fellow citizens against threats against any of us.  That means patriotic citizens who are willing to fight and die in the military against threats to the rights and freedoms from our enemies.  And it means patriotic citizens being willing to pay for our fair share to spread the risk around, standing together against threats to our health.  We don’t want our fellow citizens to be denied health insurance by insurance companies because they have pre-existing medical conditions, or to be charged so much they can’t afford it.  We don’t want our fellow citizens losing their homes because of catastrophic illness.  We don’t want our fellow citizens buried in debt which they can never repay because of some medical misfortune.  We’ve got each other’s backs.  That’s how we roll.

May God bless America, and may every American citizen be willing to shoulder their fair share of the risk to provide medical care for all, even if it means the government requiring us to buy it.


  1. Thanks, Patrick. I was listening to recordings the NYT posted of the plaintiffs, defense and supreme court justices interacting on this. Fascinating! In how many countries is there such direct access to such important conversations among those in power? And your point about only corpses being sure of not needing healthcare is well made!

  2. When laws are passed that mandate us to buy something no matter how good the product it infringes on our freedom to make good and bad choices. It is paternalistic, it implies that the govt knows better than we do what is best for us. Of course I think motorcycle helmets, car insurance, and health insurance are good, wise things to have, but if a person doesn't want them or can't buy them, they shouldn't be forced to. And the consequence of not having those things is the risk they're willing to take. There's plenty of people who willingly buy those things that the cost of any injury/illness would still be aptly covered without a huge rise in premiums.

    And yes, an alternative is nationally provided health insurance, wherein we're not forced to buy it, but care would be rationed (it has to be if everyone is to be covered) and I think most Americans would chafe at that idea. We love our freedom too much (or at least we used to) and I don't think we'd be willing to settle for that. That is not how we roll.

    Thanks for posting.

  3. CH - Thanks for your thoughtful and gracious reply. Your charge of paternalism seems to imply something other than the American notion of government of, by and for the people. In the American paradigm, the government is us - not some external power. The decisions that the government makes are our decisions, as decided by our elected representatives. At least, that's the theory.

    But even using your term for sake of argument, most everything the government does could be considered paternalistic. Why have a taxpayer funded standing army when we can defend ourselves? Why have public education which we have to pay for when we can educate our children ourselves, if we even have them? Roads, safety nets, government sponsored health clinics, vaccines - the list goes on and on. They may be great ideas, the libertarian argument goes, but don't force me to pay for them.

    However, societal obligations are part and parcel of the social compact. The will of the individual gives way to the will of the majority, within certain legal constraints. The most radical socialist can't force private property to revert to the state, for example. That would take the will of the majority. At the same time, the most radical libertarians can't derail national legislation just because they don't want to be "forced" to do it. Citizens who do not want to be required to pay for insurance have a right to express their opinions, support candidates who will advocate their views, and exercise their right to vote. If they prevail, so be it - if they don't, likewise.

    My post just goes to the question of whether it is a radical, impermissible, unconscionable action by the government to require all of its citizens to contribute to programs which protect the welfare of all citizens. Existing laws requiring liability insurance for drivers demonstrate that this type of legislation has statutory precedent, backed up by the appellate courts, in every single state in the Union.

  4. This exposes the thin thread on which the Courts can overturn this legislation. I will be interested in reading the final decision one way or the other. The court is stacked with smart people on both sides of the issue. The implications are EXPLOSIVE!!!